Jefferson Journal of Psychiatry


The use and abuse of drugs and alcohol have recently gained greater attention both from the public and the medical profession. Despite increasing cognizance of its unfortunate consequences, substance use has become a more pervasive element of contemporary society. As substance abuse has come to affect more segments of the population, it is not surprising that this problem also has affected the mentally ill. Awareness of the mentally ill substance abuser has grown, although this population has not been well studied or well served by the mental health system. These dually diagnosed patients often are depicted as the square pegs of psychiatry, not quite fitting into the round hole of mental health treatment. The reason for this is clear. Because of the current structure of the mental health service delivery system, psychiatric and substance abuse services are provided almost exclusively by independent systems (1,2). As a result, those patients who are perhaps most in need of treatment are most likely to fall through the cracks of the system. Providing services for this group of patients represents a clinical and administrative challenge, which has not been adequately addressed by the psychiatric profession. In this paper, I suggest that psychiatrists can accept greater responsibility for working with the dually diagnosed, and that this responsibility could begin with the psychiatrist-in-training. Although the problem may be difficult to overcome, psychiatry is in a unique position to accept this responsibility, effect changes in the system, and have a positive impact on the lives of patients with dual diagnoses.

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